Can someone please explain to me about the spikey profile??

[myxmastreelookspants]

Hi my Ds 7 is in the process of assessment for ASD, now when he had a full cognitive assessment done by an Educational psychologist at shool she contacted me and after giving me the results said "I'm sorry but * does not have the spikey profile that suggests ASD", firstly I was slightly annoyed that she appeared to think that I would be happy to know that he has ASD, and secondly I was wondering what exactly is the spikey profile???.

I should imagine (and that is what I am doing) that most NT children's cognitive abilities would be roughly the same throughout the different sections for example VCI = average, PRI = above average, PSI = above average, WMI = average, clustered together I suppose for want of a better word.

I understand that one size doesn't fit all in regards to ASD but is there some kind of pattern that always emerges when children on the spectrum have the cognitive assessment done??.

My Ds's results were VCI = High Average, PRI = outstanding (whatever that is on the scales?? should of asked her to clarify really), PSI = average (this did come in at below average but the EP said he was beginning to get bored with the tests but she would say he comes in at average), WMI = Low average (think that was what was said, can't remember off the top of my head it was a while ago!). Has anyone else's child had similar results as my Ds?.

Thanks

Just curious

[Lougle]

I think that because ASD is defined as 'a triad of impairment', the diagnostic 'key' is that there are deficits in Social Imagination, Social Communication and Social Relationships.

If a child is very able cognitively, but impaired in the 'triad' then ASD is very likely.

If a child is, say, 18 months behind in all areas, then despite there being a clear problem, it isn't necessarily ASD, because the delay is uniform.

If, however, the same child is 18 months behind in most areas, but 24 months behind in the 'triad' areas, then they could possibly have ASD as well as a learning disability.

[coppertop]

I can't remember ds' exact results but his tests showed a very spikey profile. Working memory was well below the low average range whereas his strongest areas were way above high average.

The Ed Psych said that this range of results was consistent with a dx of ASD.

[IndigoBelle]

I would say 'low average' to 'outstanding' is pretty spikey.

[Lougle]

Having said that, DD1 (7.0) has a very spikey profile - she can remember what acidulated water is, for example, and which ducks on the water are boys or girls, but can't read, write or spell, can't pronounce many words, etc.

Her Paediatrician has a special interest in neurodevelopment and autism, and is sure that she doesn't have ASD.

[EllenJaneisstillnotmyname]

The spikiness has to be low in the ASD type impairments to give an ASD profile, though, Lougle. Your DD may well have a spiky profile but just not one that points to ASD?

OP, my DS had a classic spiky profile during his EP assessment at age 5, which they gave, usefully, in percentiles which is much easier to understand and relate to. He ranged from above 99th for PRI and naming vocabulary to 7th VCI, particularly social meaning of language.

Looking at a percentile/stanine converter, it looks like outstanding (stanine 9) is 96%ile and above, above average (stanine 7 or 8) is 77 - 96%ile, average (stanine 4, 5 or 6) is between 23 - 77%ile, below average (stanine 2 or 3) , 4 - 23%ile and a low score (stanine 1) is 4% or less.

So a range of scores between below average to outstanding certainly sounds spiky to me. When development is spiky like this, it's said to be disordered, hence Autism Spectrum Disorder, or some other disorder.

Your DS's high VCI may be what is making the EP discount ASD, but these tests can sometimes appeal to a child's strengths. My DS's naming vocabulary was above 99th %ile, but his verbal comprehension overall was low. It could be that the tests performed on your DS didn't test any weaknesses such as social use of language, inference and deduction, or just that your DS doesn't have ASD!

[ilikemysleep]

Ummm....there is no cognitive profile that is typical of ASD and it certainly isn't diagnostic to have or not have any kind of cognitive profile. You most certainly can't rule out ASD on the absence of any kind of results from an IQ test, except if a child has very significant learning difficulties that can solely explain their social understanding difficulties (ie they are like a much younger child socially). ASD is diagnosed from behaviours, observations, early history and the ADOS, not from a cognitive assessment.

On the other hand, it can be useful to have a cognitive profile as it can highlight strengths and weaknesses and be supportive of planning for a child's needs, but it would not be correct to say because someone has not got a spikey profile (which means, a spread of scores) they can't be autistic. And in any case, if your child's scores are ranging from outstanding to below average, wouldn't that BE spikey?

[madwomanintheattic]

I think that profile is more indicative of ADHD. (Obviously not in isolation - ds scores on the outstanding range, but wm and processing are bang on average, so a 50% plunge in centiles. It isn't seen as an issue cognitively, as it is, erm, within the normal range, but is hugely important for ds as it explains his frustration etc)

In isolation, and iq test will just show areas of strength and weakness. What other tests did they do? For example, in conjunction with the wechsler stuff, they ran whole load of other asd and ADHD tests. Ds scored well below average for the ADHD subset (ie indicating definitive ADHD type issues - this would also be consistent with the difficulties in processing and working memory shown in the iq test). The ASD stuff wasn't as definitive, and so he doesn't have a formal ASD dx, but given that he does struggle with certain issues, the psych detailed this in the report, with suggestions for coping strategies.

All that said... Ds has a dx of ADHD, some aspergers traits, anxieties and phobias. Does this describe him? Is it accurate? Well, it's one way of interpreting the results.... I suspect another psych may have interpreted them slightly differently. As his FSIQ is still in the gifted range, even with his 'average' scores on 50% of the test, he does also qualify to have his high ability taken not account when putting support issues in place - one of his psychs believes that it is the giftedness/ relatively poor (but 'normal') wm and processing that is the root of the difficulties. Certainly most of the gifted centres of excellence recognise that for a child who scores in the outstanding range on iq tests, that a 50th centile score should be viewed as a learning disability in that child's particular context... Obvious in the wider arena, it would be indicative of bugger all.

In and of itself, an iq test is not a diagnostic tool of asd or ADHD. The other tests should be viewed alongside in order to make an accurate-ish guess.

[Handywoman]

MyXmasTree, my dd2 is under assessment for ASD and her developmental Paed requested an Ed Psych assessment of strengths and weaknesses across the curriculum. Said Paed put in writing that she suspects a 'spiky profile'. However, as dd2 is accessing the curriculum appropriately and the Ed Psych has rejected the referral. Paediatrician said the Ed Psych assessment is useful but lack EP assessment was absolutely NOT a barrier to diagnosis of ASD. So while the information may help to exclude or reveal a learning disability (ultimately that's what an EP assessment is good at) it doesn't appear to be instrumental in diagnosing ASD although it is possible it could support it, depending on the nature of the assessment and how sensitive that might be in picking out ASD type difficulties (assessment of higher language ability e.g. inference and non-literal language).

Having said that, my other dd DOES have a learning disability (Dyslexia) and my understanding is not the absolute values, but the discrepancies (peaks and troughs) between them that suggest a learning disability. Average/Above Average does not really give enough information, there must be specific cutoffs involving standard deviations (statistical norms) to give a distinct shape to that profile. So I guess you need to wait for the full written report and take it from there? If there is a learning disability then the report should indicate that. If not it will hopefully help to see if specific support is needed at school.

Good luck, hw x

[madwomanintheattic]

Yy, exactly - ds is at the 99.9th centile for 50% of the test, and at the 50th centile exactly, for wm and processing. That's statistically significant whichever way you swing it. I assume he did WIAT or similar as well?

Who is carrying out the ASD assessment? I'm assuming the EP stuff was just for background detail?

[CelstialNavigation]

The EP is not the only one assessing him for ASD though is she? As an EP could not give a diagnosis of ASD, and could not rule one out (especially on the basis of a cognitive profile). Also if she thought your DS was getting bored with the tests she should have stopped and resumed later.

[mymatemax]

spikey profile i always understood to mean not equally delayed or equally able in all areas of development.
ds2's "spiky profile" was one of the reasons his initiall dx of GDD was revisited.

[WeWilsonAMerryChristmas]

I'm glad I saw Celestial's post as it means I'm not the only one who thought an EP couldn't dx... What was the purpose of her tests? Was it to feed in to a pead assessment? And I would say that you do have a 'spikey' profile there actually.

[madwomanintheattic]

EP can't dx. Clinical psych working as EP in private setting can. As this was through the LA I very much doubt it was a diagnostic authority, just Ed Psych report requested for background info for diagnosing physician/ authority.

I did ask earlier who was doing the ASD assessment... (I assumed not the EP)

[myxmastreelookspants]

Hi everyone thank you for your replies, My Ds is currently being assessed by camhs (for a whole host of reasons, would take a very long post to explain) he has been observed at school, had a play based assessment, just awaiting the thorough development history on 17th which tbh I am dreading, so many things that stuck in my head but I just thought hey ho thats my boy .
After a very long and worrying 3 yrs (on our part) the school begrudgingly had Ds assessed by the EP whose specialist area is ASD, over a year ago my Ds dropped from average levels to P levels within the space of 4 weeks!! I did not find out about this until some months after and to me something was really wrong unfortunatly the school spent far to much time concentrating on his behaviour and not enough time looking for the cause. The EP did a battery of tests which camhs could of done themselves but due to other reasons (the school denying my Ds a visit by the EP due to lack of funds) they liased with the EP and she did them at the school, so what ever tests would of been carried out by camhs are the ones which she did?? After googling the info she gave me it does look as though she did the wisc. Emotional literacy was also mentioned which was below low average but I am not sure how this was tested.
I have just heard the spikey profile mentioned so many times but I can't seem to find some kind of example IYKWIM I just end up reading about aspergers, autistic spectrum disorders etc etc. I even tried looking to see about the PCI results and ended up reading about visual spatial learners which actually sounds very much like my Ds even down to the oversensitivites to light etc...makes me wonder it really does.

[myxmastreelookspants]

oopsie meant the PRI not PCI results!!